File a claim against the Workers' Compensation Trust Fund (WCTF)

To file a claim against the WCTF, you, or your attorney, will need to file 3 documents and any supporting documentation as required:

To verify that your employer has no workers’ compensation insurance.

1. Download and fill out an Insurer Request Certification Form. Mail the form to:

                         Tom Finneran
                         Office of Insurance
                         Department of Industrial Accidents
                         19 Staniford St., 5th Floor
                         Boston, MA 02114

• Or submit the request electronically at: https://www.mass.gov/doc/insurance-inquiry/download

• This form verifies that the employer has no workers' compensation insurance coverage. The Office of Insurance will send a certified letter called a Certification of No Insurance back.

2. Download and fill out the Form 170 – Affidavit of Employee in Application for Trust Fund Benefits.

3. File the Form 110 via your online account.

• Send supporting documents, Certification of No Insurance, and Form 170 – Affidavit of Employee in Application for Trust Fund Benefits to: Department of Industrial Accidents FAX (617) 727-4551 or email dia-docattach@mass.gov

4. Also send hard copies of all documents by certified mail to:

                     Workers’ Compensation Trust Fund
                     c/o Department Industrial Accidents
                     Lafayette City Center
                     2 Avenue de Lafayette
                     Boston, MA 02111-1750

5. Keep a copy for your records.